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Forró T, Manu DR, Băjenaru OL, Bălașa R. GFAP as Astrocyte-Derived Extracellular Vesicle Cargo in Acute Ischemic Stroke Patients-A Pilot Study. Int J Mol Sci 2024; 25:5726. [PMID: 38891912 PMCID: PMC11172178 DOI: 10.3390/ijms25115726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
The utility of serum glial fibrillary acidic protein (GFAP) in acute ischemic stroke (AIS) has been extensively studied in recent years. Here, we aimed to assess its potential role as a cargo protein of extracellular vesicles (EVs) secreted by astrocytes (ADEVs) in response to brain ischemia. Plasma samples from eighteen AIS patients at 24 h (D1), 7 days (D7), and one month (M1) post-symptoms onset, and nine age, sex, and cardiovascular risk factor-matched healthy controls were obtained to isolate EVs using the Exoquick ULTRA EV kit. Subsets of presumed ADEVs were identified further by the expression of the glutamate aspartate transporter (GLAST) as a specific marker of astrocytes with the Basic Exo-Flow Capture kit. Western blotting has tested the presence of GFAP in ADEV cargo. Post-stroke ADEV GFAP levels were elevated at D1 and D7 but not M1 compared to controls (p = 0.007, p = 0.019, and p = 0.344, respectively). Significant differences were highlighted in ADEV GFAP content at the three time points studied (n = 12, p = 0.027) and between D1 and M1 (z = 2.65, p = 0.023). A positive correlation was observed between the modified Rankin Scale (mRS) at D7 and ADEV GFAP at D1 (r = 0.58, p = 0.010) and D7 (r = 0.57, p = 0.013), respectively. ADEV GFAP may dynamically reflect changes during the first month post-ischemia. Profiling ADEVs from peripheral blood could provide a new way to assess the central nervous system pathology.
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Affiliation(s)
- Timea Forró
- Doctoral School of Medicine and Pharmacy, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania;
| | - Doina Ramona Manu
- Center for Advanced Medical and Pharmaceutical Research, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Ovidiu-Lucian Băjenaru
- Discipline of Geriatrics and Gerontology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- National Institute of Gerontology and Geriatrics “Ana Aslan”, 11241 Bucharest, Romania
| | - Rodica Bălașa
- 1st Neurology Clinic, County Emergency Clinical Hospital of Targu Mures, 540136 Targu Mures, Romania;
- Department of Neurology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
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2
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Marto JP, Carvalho AS, G. Mollet I, Mendonça M, Salavisa M, Meira B, Fernandes M, Serrazina F, Cabral G, Ventura R, Sobral‐Pinho A, Beck HC, Vieira HLA, Viana‐Baptista M, Matthiesen R. Proteomics to Identify New Blood Biomarkers for Diagnosing Patients With Acute Stroke. J Am Heart Assoc 2023; 12:e030021. [PMID: 37947097 PMCID: PMC10727303 DOI: 10.1161/jaha.123.030021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
Background Blood biomarkers are a potential tool for early stroke diagnosis. We aimed to perform a pilot and exploratory study on untargeted blood biomarkers in patients with suspected stroke by using mass spectrometry analysis. Methods and Results This was a prospective observational study of consecutive patients with suspected stroke admitted within 6 hours of last being seen well. Blood samples were collected at admission. Patients were divided into 3 groups: ischemic stroke (IS), intracerebral hemorrhage (ICH), and stroke mimics. Quantitative analysis from mass spectrometry data was performed using a supervised approach. Biomarker-based prediction models were developed to differentiate IS from ICH and ICH+stroke mimics. Models were built aiming to minimize misidentification of patients with ICH as having IS. We included 90 patients, one-third within each subgroup. The median age was 71 years (interquartile range, 57-81 years), and 49 participants (54.4%) were women. In quantitative analysis, C3 (complement component 3), ICAM-2 (intercellular adhesion molecule 2), PLGLA (plasminogen like A), STXBP5 (syntaxin-binding protein 5), and IGHV3-64 (immunoglobulin heavy variable 3-64) were the 5 most significantly dysregulated proteins for both comparisons. Biomarker-based models showed 88% sensitivity and 89% negative predictive value for differentiating IS from ICH, and 75% sensitivity and 95% negative predictive value for differentiating IS from ICH+stroke mimics. ICAM-2, STXBP5, PLGLA, C3, and IGHV3-64 displayed the highest importance score in our models, being the most informative for identifying patients with stroke. Conclusions In this proof-of-concept and exploratory study, our biomarker-based prediction models, including ICAM-2, STXBP5, PLGLA, C3, and IGHV3-64, showed 75% to 88% sensitivity for identifying patients with IS, while aiming to minimize misclassification of ICH. Although our methodology provided an internal validation, these results still need validation in other cohorts and with different measurement techniques.
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Affiliation(s)
- João Pedro Marto
- Department of NeurologyHospital de Egas Moniz, Centro Hospitalar Lisboa OcidentalLisbonPortugal
- Centro Clínico Académico de Lisboa (CCAL), NOVA Medical School (MNS)LisbonPortugal
| | - Ana Sofia Carvalho
- iNOVA4Health, NOVA Medical SchoolUniversidade NOVA de LisboaLisbonPortugal
| | - Inês G. Mollet
- iNOVA4Health, NOVA Medical SchoolUniversidade NOVA de LisboaLisbonPortugal
- UCIBIO, Applied Molecular Biosciences Unit, NOVA School of Science and TechnologyUniversidade NOVA de LisboaCaparicaPortugal
- i4HB—Institute for Health and Bioeconomy, NOVA School of Science and TechnologyUniversidade NOVA de LisboaCaparicaPortugal
| | - Marcelo Mendonça
- iNOVA4Health, NOVA Medical SchoolUniversidade NOVA de LisboaLisbonPortugal
- Champalimaud Research and Clinical CentreChampalimaud FoundationLisbonPortugal
| | - Manuel Salavisa
- Department of NeurologyHospital de Egas Moniz, Centro Hospitalar Lisboa OcidentalLisbonPortugal
| | - Bruna Meira
- Department of NeurologyHospital de Egas Moniz, Centro Hospitalar Lisboa OcidentalLisbonPortugal
| | - Marco Fernandes
- Department of NeurologyHospital de Egas Moniz, Centro Hospitalar Lisboa OcidentalLisbonPortugal
| | - Filipa Serrazina
- Department of NeurologyHospital de Egas Moniz, Centro Hospitalar Lisboa OcidentalLisbonPortugal
| | - Gonçalo Cabral
- Department of NeurologyHospital de Egas Moniz, Centro Hospitalar Lisboa OcidentalLisbonPortugal
| | - Rita Ventura
- Department of NeurologyHospital de Egas Moniz, Centro Hospitalar Lisboa OcidentalLisbonPortugal
| | - André Sobral‐Pinho
- Department of NeurologyHospital de Egas Moniz, Centro Hospitalar Lisboa OcidentalLisbonPortugal
| | - Hans C. Beck
- Department of Clinical BiochemistryOdense University HospitalOdenseDenmark
| | - Helena L. A. Vieira
- iNOVA4Health, NOVA Medical SchoolUniversidade NOVA de LisboaLisbonPortugal
- UCIBIO, Applied Molecular Biosciences Unit, NOVA School of Science and TechnologyUniversidade NOVA de LisboaCaparicaPortugal
- i4HB—Institute for Health and Bioeconomy, NOVA School of Science and TechnologyUniversidade NOVA de LisboaCaparicaPortugal
| | - Miguel Viana‐Baptista
- Department of NeurologyHospital de Egas Moniz, Centro Hospitalar Lisboa OcidentalLisbonPortugal
- Centro Clínico Académico de Lisboa (CCAL), NOVA Medical School (MNS)LisbonPortugal
| | - Rune Matthiesen
- iNOVA4Health, NOVA Medical SchoolUniversidade NOVA de LisboaLisbonPortugal
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3
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Zilinskaite N, Shukla RP, Baradoke A. Use of 3D Printing Techniques to Fabricate Implantable Microelectrodes for Electrochemical Detection of Biomarkers in the Early Diagnosis of Cardiovascular and Neurodegenerative Diseases. ACS MEASUREMENT SCIENCE AU 2023; 3:315-336. [PMID: 37868357 PMCID: PMC10588936 DOI: 10.1021/acsmeasuresciau.3c00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 10/24/2023]
Abstract
This Review provides a comprehensive overview of 3D printing techniques to fabricate implantable microelectrodes for the electrochemical detection of biomarkers in the early diagnosis of cardiovascular and neurodegenerative diseases. Early diagnosis of these diseases is crucial to improving patient outcomes and reducing healthcare systems' burden. Biomarkers serve as measurable indicators of these diseases, and implantable microelectrodes offer a promising tool for their electrochemical detection. Here, we discuss various 3D printing techniques, including stereolithography (SLA), digital light processing (DLP), fused deposition modeling (FDM), selective laser sintering (SLS), and two-photon polymerization (2PP), highlighting their advantages and limitations in microelectrode fabrication. We also explore the materials used in constructing implantable microelectrodes, emphasizing their biocompatibility and biodegradation properties. The principles of electrochemical detection and the types of sensors utilized are examined, with a focus on their applications in detecting biomarkers for cardiovascular and neurodegenerative diseases. Finally, we address the current challenges and future perspectives in the field of 3D-printed implantable microelectrodes, emphasizing their potential for improving early diagnosis and personalized treatment strategies.
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Affiliation(s)
- Nemira Zilinskaite
- Wellcome/Cancer
Research UK Gurdon Institute, Henry Wellcome Building of Cancer and
Developmental Biology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QN, U.K.
- Faculty
of Medicine, University of Vilnius, M. K. Čiurlionio g. 21, LT-03101 Vilnius, Lithuania
| | - Rajendra P. Shukla
- BIOS
Lab-on-a-Chip Group, MESA+ Institute for Nanotechnology, Max Planck
Center for Complex Fluid Dynamics, University
of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Ausra Baradoke
- Wellcome/Cancer
Research UK Gurdon Institute, Henry Wellcome Building of Cancer and
Developmental Biology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QN, U.K.
- Faculty
of Medicine, University of Vilnius, M. K. Čiurlionio g. 21, LT-03101 Vilnius, Lithuania
- BIOS
Lab-on-a-Chip Group, MESA+ Institute for Nanotechnology, Max Planck
Center for Complex Fluid Dynamics, University
of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
- Center for
Physical Sciences and Technology, Savanoriu 231, LT-02300 Vilnius, Lithuania
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4
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Zhou Z, Sun F, Jiang J, Dou Z, Lv Y, Zhang Z, Zhou X, Zhao X, Qin Y, Huang B. Establishment and Clinical Application in Stroke of a Serum Copeptin Time-Resolved Fluorescence Immunoassay. J Fluoresc 2023:10.1007/s10895-023-03441-7. [PMID: 37782447 DOI: 10.1007/s10895-023-03441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023]
Abstract
The serum biomarker copeptin, an innovative and stable substitute biomarker of vasopressin, is associated with stroke. Therefore, establishing a highly sensitive time-resolved fluorescence immunoassay for copeptin (copeptin-TRFIA) is helpful to measure stroke and evaluate its value in clinical applications. Double antibody sandwich was used to establish copeptin-TRFIA. The established method was then assessed. Two coated and Eu3+-labeled copeptin monoclonal specific antibodies targeting different antigen epitopes were employed. The serum fluorescence counts of patients with stroke and healthy volunteers were detected by using the well-established copeptin-TRFIA. Serum copeptin levels were measured and analyzed statistically. The actual measurement linearity range of the proposed method was 0.13-44.66 ng/mL. Copeptin-TRFIA had the inter-assay coefficient of variation (CV) of 6.49%-9.08% and the intra-assay CV of 4.75%-7.77%. Patients with cerebral infarction (CI) and intracerebral hemorrhage (ICH) had significantly higher serum copeptin levels than healthy subjects. Copeptin concentrations in the serum of patients with stroke were significantly correlated with the scores of the National Institute for Healthy Stroke Scale (NIHSS) and modified Rankin Scale (mRS). A highly sensitive copeptin-TRFIA was successfully established. Serum copeptin has a certain value in the clinical diagnosis and prognosis of stroke.
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Affiliation(s)
- Zixuan Zhou
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Fan Sun
- Department of Neurology, Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- The Affiliated hospital of Chengde Medical University, Chengde, China
| | - Jingwen Jiang
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Zhijie Dou
- The Affiliated hospital of Chengde Medical University, Chengde, China
| | - Yinglei Lv
- The Affiliated hospital of Chengde Medical University, Chengde, China
| | - Zhimin Zhang
- The Affiliated hospital of Chengde Medical University, Chengde, China
| | - Xiumei Zhou
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Xueqin Zhao
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China
| | - Yuan Qin
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China.
| | - Biao Huang
- College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China.
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5
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Li Q, Zhao L, Chan CL, Zhang Y, Tong SW, Zhang X, Ho JWK, Jiao Y, Rainer TH. Multi-Level Biomarkers for Early Diagnosis of Ischaemic Stroke: A Systematic Review and Meta-Analysis. Int J Mol Sci 2023; 24:13821. [PMID: 37762122 PMCID: PMC10530879 DOI: 10.3390/ijms241813821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Blood biomarkers hold potential for the early diagnosis of ischaemic stroke (IS). We aimed to evaluate the current weight of evidence and identify potential biomarkers and biological pathways for further investigation. We searched PubMed, EMBASE, the Cochrane Library and Web of Science, used R package meta4diag for diagnostic meta-analysis and applied Gene Ontology (GO) analysis to identify vital biological processes (BPs). Among 8544 studies, we included 182 articles with a total of 30,446 participants: 15675 IS, 2317 haemorrhagic stroke (HS), 1798 stroke mimics, 846 transient ischaemic attack and 9810 control subjects. There were 518 pooled biomarkers including 203 proteins, 114 genes, 108 metabolites and 88 transcripts. Our study generated two shortlists of biomarkers for future research: one with optimal diagnostic performance and another with low selection bias. Glial fibrillary acidic protein was eligible for diagnostic meta-analysis, with summary sensitivities and specificities for differentiating HS from IS between 3 h and 24 h after stroke onset ranging from 73% to 80% and 77% to 97%, respectively. GO analysis revealed the top five BPs associated with IS. This study provides a holistic view of early diagnostic biomarkers in IS. Two shortlists of biomarkers and five BPs warrant future investigation.
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Affiliation(s)
- Qianyun Li
- Department of Emergency Medicine, University of Hong Kong, Hong Kong, China; (Q.L.)
| | - Lingyun Zhao
- Department of Emergency Medicine, University of Hong Kong, Hong Kong, China; (Q.L.)
| | - Ching Long Chan
- Department of Emergency Medicine, University of Hong Kong, Hong Kong, China; (Q.L.)
| | - Yilin Zhang
- Department of Emergency Medicine, University of Hong Kong, Hong Kong, China; (Q.L.)
| | - See Wai Tong
- Department of Emergency Medicine, University of Hong Kong, Hong Kong, China; (Q.L.)
| | - Xiaodan Zhang
- Department of Emergency Medicine, University of Hong Kong, Hong Kong, China; (Q.L.)
| | - Joshua Wing Kei Ho
- School of Biomedical Sciences, University of Hong Kong, Hong Kong, China
| | - Yaqing Jiao
- Department of Emergency Medicine, University of Hong Kong, Hong Kong, China; (Q.L.)
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6
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di Biase L, Bonura A, Pecoraro PM, Carbone SP, Di Lazzaro V. Unlocking the Potential of Stroke Blood Biomarkers: Early Diagnosis, Ischemic vs. Haemorrhagic Differentiation and Haemorrhagic Transformation Risk: A Comprehensive Review. Int J Mol Sci 2023; 24:11545. [PMID: 37511304 PMCID: PMC10380631 DOI: 10.3390/ijms241411545] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Stroke, a complex and heterogeneous disease, is a leading cause of morbidity and mortality worldwide. The timely therapeutic intervention significantly impacts patient outcomes, but early stroke diagnosis is challenging due to the lack of specific diagnostic biomarkers. This review critically examines the literature for potential biomarkers that may aid in early diagnosis, differentiation between ischemic and hemorrhagic stroke, and prediction of hemorrhagic transformation in ischemic stroke. After a thorough analysis, four promising biomarkers were identified: Antithrombin III (ATIII), fibrinogen, and ischemia-modified albumin (IMA) for diagnostic purposes; glial fibrillary acidic protein (GFAP), micro RNA 124-3p, and a panel of 11 metabolites for distinguishing between ischemic and hemorrhagic stroke; and matrix metalloproteinase-9 (MMP-9), s100b, and interleukin 33 for predicting hemorrhagic transformation. We propose a biomarker panel integrating these markers, each reflecting different pathophysiological stages of stroke, that could significantly improve stroke patients' early detection and treatment. Despite promising results, further research and validation are needed to demonstrate the clinical utility of this proposed panel for routine stroke treatment.
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Affiliation(s)
- Lazzaro di Biase
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Brain Innovations Lab, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Adriano Bonura
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Pasquale Maria Pecoraro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Simona Paola Carbone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Vincenzo Di Lazzaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
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7
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Simani L, Ramezani M, Mohammadi E, Abbaszadeh F, Karimialavijeh E, Pakdaman H. Association of Changed Serum Brain Biomarkers With Perihematomal Edema and Early Clinical Outcome in Primary ICH Patients. Neurologist 2022; 27:168-172. [PMID: 34855658 DOI: 10.1097/nrl.0000000000000400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perihematomal edema (PHE) following primary intracranial hemorrhages (ICHs) affects the patient outcome. Also, serum biomarkers such as S100 calcium-binding protein B (S100B) and glial fibrillary acidic protein (GFAP) have been associated with ICHs outcome. We aimed to investigate the association between these biomarkers and PHE in ICH patients. METHODS In this cross-sectional study, patients with primary ICH between January 2020 and August 2020 were evaluated. All participants underwent spiral brain computed tomography scans upon admission, and 48 to 72 hours later and quantification of initial hematoma volume was performed. Serum level of matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEGF), GFAP, and S100B on admission were measured by enzyme-linked immunosorbent assays. Acute clinical outcome was assessed by the modified-Rankin scale, National Institute of Health Stroke Scale (NIHSS), and ICH score. RESULTS Thirty-seven ICH patients (21 patients with a favorable outcome and 16 unfavorable) were studied. Compared with survival patients, nonsurvivor patients showed a higher serum level of MMP-9, VEGF, GFAP, and S100B ( P <0.05). Scores of absolute PHE, edema expansion distance, and PHE growth rate in the nonsurvivor group were higher than the survivors ( P <0.001). The regression model revealed that MMP-9, VEGF, ICH score, and hematoma volume were associated with the PHE growth rate. S100B and ICH score were associated with edema expansion distance. CONCLUSIONS Our data showed that the serum level of molecular biomarkers was associated with higher PHE volume and PHE scores were higher in nonsurvival patients, suggesting it may have a pathogenic role in developing PHE after ICH.
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Affiliation(s)
- Leila Simani
- Skull Base Research Center
- Brain Mapping Research Center, Loghman Hakim Hospital
| | - Mahtab Ramezani
- Skull Base Research Center
- Brain Mapping Research Center, Loghman Hakim Hospital
| | | | - Fatemeh Abbaszadeh
- Neurobiology Research Center, Shahid Beheshti University of Medical Sciences
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences (IUMS)
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8
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Patil S, Rossi R, Jabrah D, Doyle K. Detection, Diagnosis and Treatment of Acute Ischemic Stroke: Current and Future Perspectives. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:748949. [PMID: 35813155 PMCID: PMC9263220 DOI: 10.3389/fmedt.2022.748949] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 06/02/2022] [Indexed: 11/30/2022] Open
Abstract
Stroke is one of the leading causes of disability worldwide. Early diagnosis and treatment of stroke are important for better clinical outcome. Rapid and accurate diagnosis of stroke subtypes is critical. This review discusses the advantages and disadvantages of the current diagnostic and assessment techniques used in clinical practice, particularly for diagnosing acute ischemic stroke. Alternative techniques for rapid detection of stroke utilizing blood based biomarkers and novel portable devices employing imaging methods such as volumetric impedance phase-shift spectroscopy, microwave tomography and Doppler ultrasound are also discussed. Current therapeutic approaches for treating acute ischemic stroke using thrombolytic drugs and endovascular thrombectomy are discussed, with a focus on devices and approaches recently developed to treat large cranial vessel occlusions.
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Affiliation(s)
- Smita Patil
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Rosanna Rossi
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Duaa Jabrah
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Karen Doyle
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
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9
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Sayad A, Uddin SM, Yao S, Wilson H, Chan J, Zhao H, Donnan G, Davis S, Skafidas E, Yan B, Kwan P. A magnetoimpedance biosensor microfluidic platform for detection of glial fibrillary acidic protein in blood for acute stroke classification. Biosens Bioelectron 2022; 211:114410. [PMID: 35617799 DOI: 10.1016/j.bios.2022.114410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022]
Abstract
Acute stroke is the third leading cause of mortality and disability worldwide. Administration of appropriate therapy for acute stroke is critically dependent on timely classification into either ischemic or hemorrhagic subtypes, which have divergent treatment pathways. The current classification method is based on neuroimaging, which generally requires the transport of the patient to a hospital-based facility unless a mobile stroke unit is available. Plasma glial fibrillary acidic protein (GFAP) level has been identified as a useful blood-based biomarker to differentiate stroke subtypes. However, its conventional immunoassay methods are laboratory-based and time-consuming. Novel approaches for rapid stroke classification near the patients are urgently needed. Here, we report the development and testing of a microfluidic-based magnetoimpedance biosensor platform for measuring GFAP levels. The platform consists of a microfluidic chip for GFAP extraction from a blood sample and a magnetoimpedance (MI) biosensor that employs Dynabeads as a magnetic label to capture the GFAP molecules. We demonstrated the detection of recombinant GFAP protein in phosphate-buffered saline (PBS) and in mouse blood samples (detection limit 0.01 ng/mL) and of physiological GFAP in blood and plasma samples (detection limit 1.0 ng/mL) obtained from acute stroke patients. This detection level is within the range of cut-off levels required for clinical stroke subtype differentiation. This platform has the potential to be incorporated into a small device with further development to assist in the classification of acute stroke patients and clinical decision-making at the point-of-care.
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Affiliation(s)
- Abkar Sayad
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia.
| | - Shah Mukim Uddin
- Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia.
| | - Scarlett Yao
- Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia.
| | - Harold Wilson
- Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia. https://
| | - Jianxiong Chan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia; Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia.
| | - Henry Zhao
- Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia; Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, VIC, 3010, Australia.
| | - Geoffrey Donnan
- Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia; Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, VIC, 3010, Australia.
| | - Stephen Davis
- Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia; Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, VIC, 3010, Australia. https://
| | - Efstratios Skafidas
- Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia; Department of Electrical and Electronic Engineering, Melbourne School of Engineering, The University of Melbourne, VIC, 3010, Australia.
| | - Bernard Yan
- Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia; Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, VIC, 3010, Australia.
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia; Department of Medicine, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia; Department of Electrical and Electronic Engineering, Melbourne School of Engineering, The University of Melbourne, VIC, 3010, Australia; Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, VIC, 3010, Australia.
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10
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The diagnostic and prognostic value of glial fibrillary acidic protein in traumatic brain injury: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2022; 49:1235-1246. [PMID: 35525877 DOI: 10.1007/s00068-022-01979-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/16/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Over the years, blood biomarkers have been extensively applied for diagnostic and prognostic assessment of traumatic brain injury (TBI). Herein, we conducted a meta-analysis to evaluate the diagnostic and prognostic value of glial fibrillary acidic protein (GFAP) for TBI patients. METHODS The online databases, including PubMed, Embase, Cochrane Library, CNKI, and WFSD, were systematically retrieved from inception until May 2021. The RevMan 5.3 software and Stata 15 were used to conduct data analysis. RESULTS A total of 22 eligible studies comprising 3709 patients were included in this meta-analysis. The pooled results indicated that serum GFAP had a diagnostic value in detecting traumatic intracranial lesions (AUC 0.81; 95% CI 0.77-0.84; p < 0.00001). The pooled sensitivity and specificity were 0.93 (95% CI 0.81-0.98), and 0.66 (95% 0.53-0.77; p < 0.00001), respectively. For assessment of unfavorable outcome, the pooled sensitivity, specificity and AUC value were 0.66 (95% CI 0.54-0.76; p < 0.00001), 0.82(95% CI 0.72-0.90; p < 0.00001), and 0.82 (95% CI 0.76-0.88; p < 0.00001), respectively. Besides, GFAP exhibited a significant value in predicting mortality (AUC 0.81; 95% CI 0.77-0.84; p < 0.00001), with high sensitivity and specificity (0.86, 95% CI 0.79-0.92, p < 0.00001, and 0.66, 95% CI 0.52-0.77, p < 0.00001). The subgroup analysis indicated that the type of TBI and cut-off value were potential sources of heterogeneity, which influenced the pooled AUC values for mortality prediction. CONCLUSIONS Our meta-analysis indicated that GFAP had diagnostic and prognostic value for TBI patients, especially during the early TBI.
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11
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Malicek D, Wittig I, Luger S, Foerch C. Proteomics-Based Approach to Identify Novel Blood Biomarker Candidates for Differentiating Intracerebral Hemorrhage From Ischemic Stroke-A Pilot Study. Front Neurol 2022; 12:713124. [PMID: 34975707 PMCID: PMC8719589 DOI: 10.3389/fneur.2021.713124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: A reliable distinction between ischemic stroke (IS) and intracerebral hemorrhage (ICH) is required for diagnosis-specific treatment and effective secondary prevention in patients with stroke. However, in resource-limited settings brain imaging, which is the current diagnostic gold standard for this purpose, is not always available in time. Hence, an easily accessible and broadly applicable blood biomarker-based diagnostic test differing stroke subtypes would be desirable. Using an explorative proteomics approach, this pilot study aimed to identify novel blood biomarker candidates for distinguishing IS from ICH. Material and Methods: Plasma samples from patients with IS and ICH were drawn during hospitalization and were analyzed by using liquid chromatography/mass spectrometry. Proteins were identified using the human reference proteome database UniProtKB, and label-free quantification (LFQ) data were further analyzed using bioinformatic tools. Results: Plasma specimens of three patients with IS and four patients with ICH with a median National Institute of Health Stroke Scale (NIHSS) of 12 [interquartile range (IQR) 10.5–18.5] as well as serum samples from two healthy volunteers were analyzed. Among 495 identified protein groups, a total of 368 protein groups exhibited enough data points to be entered into quantitative analysis. Of the remaining 22 top-listed proteins, a significant difference between IS and ICH was found for Carboxypeptidase N subunit 2 (CPN2), Coagulation factor XII (FXII), Plasminogen, Mannan-binding lectin serine protease 1, Serum amyloid P-component, Paraoxonase 1, Carbonic anhydrase 1, Fibulin-1, and Granulins. Discussion: In this exploratory proteomics-based pilot study, nine candidate biomarkers for differentiation of IS and ICH were identified. The proteins belong to the immune system, the coagulation cascade, and the apoptosis system, respectively. Further investigations in larger cohorts of patients with stroke using additional biochemical analysis methods, such as ELISA or Western Blotting are now necessary to validate these markers, and to characterize diagnostic accuracy with regard to the development of a point-of-care-system for use in resource-limited areas.
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Affiliation(s)
- David Malicek
- Department of Neurology, Goethe University/University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ilka Wittig
- Functional Proteomics, Institute of Cardiovascular Physiology, Faculty of Medicine, Goethe University, Frankfurt am Main, Germany
| | - Sebastian Luger
- Department of Neurology, Goethe University/University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian Foerch
- Department of Neurology, Goethe University/University Hospital Frankfurt, Frankfurt am Main, Germany
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12
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Wu LY, Cheah IK, Chong JR, Chai YL, Tan JY, Hilal S, Vrooman H, Chen CP, Halliwell B, Lai MKP. Low plasma ergothioneine levels are associated with neurodegeneration and cerebrovascular disease in dementia. Free Radic Biol Med 2021; 177:201-211. [PMID: 34673145 DOI: 10.1016/j.freeradbiomed.2021.10.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/12/2021] [Accepted: 10/17/2021] [Indexed: 12/15/2022]
Abstract
Ergothioneine (ET) is a dietary amino-thione with strong antioxidant and cytoprotective properties and has possible therapeutic potential for neurodegenerative and vascular diseases. Decreased blood concentrations of ET have been found in patients with mild cognitive impairment, but its status in neurodegenerative and vascular dementias is currently unclear. To address this, a cross-sectional study was conducted on 496 participants, consisting of 88 with no cognitive impairment (NCI), 201 with cognitive impairment, no dementia (CIND) as well as 207 with dementia, of whom 160 have Alzheimer's Disease (AD) and 47 have vascular dementia. All subjects underwent blood-draw, neuropsychological assessments, as well as neuroimaging assessments of cerebrovascular diseases (CeVD) and brain atrophy. Plasma ET as well as its metabolite l-hercynine were measured using high sensitivity liquid chromatography tandem-mass spectrometry (LC-MS/MS). Plasma ET concentrations were lowest in dementia (p < 0.001 vs. NCI and CIND), with intermediate levels in CIND (p < 0.001 vs. NCI). A significant increase in l-hercynine to ET ratio was also observed in dementia (p < 0.01 vs. NCI). In multivariate models adjusted for demographic and vascular risk factors, lower levels of ET were significantly associated with dementia both with or without CeVD, while ET associations with CIND were significant only in the presence of CeVD. Furthermore, lower ET levels were also associated with white matter hyperintensities and brain atrophy markers (reduced global cortical thickness and hippocampal volumes). The incremental decreases in ET levels along the CIND-dementia clinical continuum suggest that low levels of ET are associated with disease severity and could be a potential biomarker for cognitive impairment. Deficiency of ET may contribute towards neurodegeneration- and CeVD-associated cognitive impairments, possibly via the exacerbation of oxidative stress in these conditions.
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Affiliation(s)
- Liu-Yun Wu
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge Singapore; Memory Aging and Cognition Centre, National University Health System, Kent Ridge, Singapore
| | - Irwin K Cheah
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore; Life Science Institute, Neurobiology Programme, Centre for Life Sciences, National University of Singapore, Singapore
| | - Joyce Ruifen Chong
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge Singapore; Memory Aging and Cognition Centre, National University Health System, Kent Ridge, Singapore
| | - Yuek Ling Chai
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge Singapore; Memory Aging and Cognition Centre, National University Health System, Kent Ridge, Singapore
| | - Jia Yun Tan
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore; Life Science Institute, Neurobiology Programme, Centre for Life Sciences, National University of Singapore, Singapore
| | - Saima Hilal
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge Singapore; Memory Aging and Cognition Centre, National University Health System, Kent Ridge, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Departments of Epidemiology and Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henri Vrooman
- Departments of Epidemiology and Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Christopher P Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge Singapore; Memory Aging and Cognition Centre, National University Health System, Kent Ridge, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore
| | - Barry Halliwell
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore; Life Science Institute, Neurobiology Programme, Centre for Life Sciences, National University of Singapore, Singapore.
| | - Mitchell K P Lai
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge Singapore; Memory Aging and Cognition Centre, National University Health System, Kent Ridge, Singapore.
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13
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Chen CH, Chu HJ, Hwang YT, Lin YH, Lee CW, Tang SC, Jeng JS. Plasma neurofilament light chain level predicts outcomes in stroke patients receiving endovascular thrombectomy. J Neuroinflammation 2021; 18:195. [PMID: 34511123 PMCID: PMC8436486 DOI: 10.1186/s12974-021-02254-4] [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] [Received: 03/31/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Timely endovascular thrombectomy (EVT) significantly improves outcomes in patients with acute ischemic stroke (AIS) with large vessel occlusion type. However, whether certain central nervous system-specific plasma biomarkers correlate with the outcomes is unknown. We evaluated the temporal changes and prognostic roles of the levels of these biomarkers in patients with AIS undergoing EVT. Methods We enrolled 60 patients who received EVT for AIS and 14 controls. The levels of plasma biomarkers, namely neurofilament light chain (NfL), glial fibrillary astrocytic protein (GFAP), tau, and ubiquitin C-terminal hydrolase L1 (UCHL1), were measured with an ultrasensitive single molecule array before, immediately after, and 24 h after EVT (T1, T2, and T3, respectively). The outcomes of interest were death or disability at 90 days (defined as a modified Rankin Scale score of 3–6) and types of hemorrhagic transformation (hemorrhagic infarction or parenchymal hemorrhage). Results Of the 180 blood samples from the 60 patients who received EVT, the plasma NfL, GFAP, and UCHL1 levels at T1 were significantly higher than those of the controls, and the levels of all four biomarkers were significantly higher at T3. Patients with parenchymal hemorrhage had a significantly higher rate of increase in GFAP (Pinteraction = 0.005) and UCHL1 (Pinteraction = 0.007) levels compared with those without parenchymal hemorrhage. In a multivariable analysis with adjustment for age, sex, National Institute of Health Stroke Scale score, history of atrial fibrillation, and recanalization status, higher NfL levels at T1 (odds ratio [OR] 2.05; 95% confidence interval [CI], 1.03–4.08), T2 (OR, 2.08; 95% CI, 1.05–4.01), and T3 (OR, 3.94; 95% CI, 1.44–10.79) were independent predictors of death or disability at 90 days. Conclusion Among patients with AIS who received EVT, those with hemorrhagic transformation exhibited significant increase in plasma GFAP and UCHL1 levels over time. Higher plasma NfL were predictive of unfavorable functional outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-021-02254-4.
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Affiliation(s)
- Chih-Hao Chen
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hai-Jui Chu
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Yi-Ting Hwang
- Department of Statistics, National Taipei University, New Taipei City, Taiwan
| | - Yen-Heng Lin
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Wei Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
| | - Sung-Chun Tang
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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14
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Kalra LP, Khatter H, Ramanathan S, Sapehia S, Devi K, Kaliyaperumal A, Bal D, Sebastian I, Kakarla R, Singhania A, Rathore S, Klinsing S, Pandian JD, Foerch C. Serum GFAP for stroke diagnosis in regions with limited access to brain imaging (BE FAST India). Eur Stroke J 2021; 6:176-184. [PMID: 34414293 PMCID: PMC8370074 DOI: 10.1177/23969873211010069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/19/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction Despite a high burden of stroke, access to rapid brain imaging is limited in many middle- and low-income countries. Previous studies have described the astroglial protein GFAP (glial fibrillary acidic protein) as a biomarker of intracerebral hemorrhage. The aim of this study was to test the diagnostic accuracy of GFAP for ruling out intracranial hemorrhage in a prospective cohort of Indian stroke patients. Patients and methods This study was conducted in an Indian tertiary hospital (Christian Medical College, Ludhiana). Patients with symptoms suggestive of acute stroke admitted within 12 h of symptom onset were enrolled. Blood samples were collected at hospital admission. Single Molecule Array technology was used for determining serum GFAP concentrations. Results A total number of 155 patients were included (70 intracranial hemorrhage, 75 ischemic stroke, 10 stroke mimics). GFAP serum concentrations were elevated in intracranial hemorrhage patients compared to ischemic stroke patients [median (interquartile range) 2.36 µg/L (0.61–7.16) vs. 0.18 µg/L (0.11–0.38), p < 0.001]. Stroke mimics patients had a median GFAP serum level of 0.14 µg/L (0.09–0.26). GFAP values below the cut-off of 0.33 µg/L (area under the curve 0.871) ruled out intracranial hemorrhage with a negative predictive value of 89.7%, (at a sensitivity for detecting intracranial hemorrhage of 90.0%). Discussion The high negative predictive value of a GFAP test system allows ruling out patients with intracranial hemorrhage. Conclusion In settings where immediate brain imaging is not available, this would enable to implement secondary prevention (e.g., aspirin) in suspected ischemic stroke patients as soon as possible.
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Affiliation(s)
- Love-Preet Kalra
- Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Himani Khatter
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | | | - Sameer Sapehia
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Kavita Devi
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | | | - Deepti Bal
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Ivy Sebastian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Raviteja Kakarla
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Anusha Singhania
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Shubhra Rathore
- Department of Radiology, Christian Medical College, Ludhiana, Punjab, India
| | - Svenja Klinsing
- Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | | | - Christian Foerch
- Department of Neurology, Goethe-University, Frankfurt am Main, Germany
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15
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Karakus A, Girerd N, Sanchez JC, Sabben C, Wietrich A, Lavandier K, Marchal S, Aubertin A, Humbertjean L, Mione G, Bouali S, Duarte K, Reymond S, Gory B, Richard S. Identifying patients with cerebral infarction within the time window compatible with reperfusion therapy, diagnostic performance of glutathione S-transferase-π (GST-π) and peroxiredoxin 1 (PRDX1): exploratory prospective multicentre study FLAG-1 protocol. BMJ Open 2021; 11:e046167. [PMID: 34417212 PMCID: PMC8381327 DOI: 10.1136/bmjopen-2020-046167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Plasma biomarkers may be useful in diagnosing acute cerebral infarction requiring urgent reperfusion, but their performance remains to be confirmed. If confirmed, these molecules could be used to develop rapid and reliable decentralised measurement methods, making it possible to initiate reperfusion therapy before hospital admission. The FLAG-1 large prospective study will constitute a plasma bank to assess the diagnostic performance of two biomarkers: glutathione S-transferase-π and peroxiredoxin 1. These molecules are involved in the oxidative stress response and could identify cerebral infarction within a therapeutic window of less than 4.5 hours following the onset of symptoms. Secondary objectives include assessing performance of these biomarkers within 3-hour and 6-hour windows; identifying additional biomarkers diagnosing cerebral infarction and significant criteria guiding therapeutic decisions: ischaemic features of stroke, presence of diffusion/fluid-attenuated inversion recovery mismatch, volume of cerebral infarction and penumbra on cerebral MRI. METHODS AND ANALYSIS The exploratory, prospective, multicentre FLAG-1 Study will include 945 patients with acute stroke symptoms (onset ≤12 hours, National Institute of Health Stroke Scale score ≥3). Each patient's 25 mL blood sample will be associated with cerebral MRI data. Two patient groups will be defined based on the time of blood collection (before and after 4.5 hours following onset). Receiver operating characteristic analysis will determine the diagnostic performance of each biomarker, alone or in combination, for the identification of cerebral infarction <4.5 hours. ETHICS AND DISSEMINATION The protocol has been approved by an independent ethics committee. Biological samples are retained in line with best practices and procedures, in accordance with French legislation. Anonymised data and cerebral imaging records are stored using electronic case report forms and a secure server, respectively, registered with the French Data Protection Authority (Commission Nationale de l'Informatique et des Libertés (CNIL)). Results will be disseminated through scientific meetings and publication in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03364296).
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Affiliation(s)
- Arif Karakus
- Department of Neurology, Stroke Unit, University Hospital Centre Nancy, 54035 Nancy, France
- University of Lorraine, Nancy, France
| | - Nicolas Girerd
- University of Lorraine, Nancy, France
- Plurithematic Clinical Investigation Center, CIC-P 1433, INSERM U1116, University Hospital Centre Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Jean-Charles Sanchez
- Department of Human Protein Sciences, University of Geneva Medical Centre, 1206 Geneva, Switzerland
| | | | - Anthony Wietrich
- Stroke Unit, Bar-le-Duc Hospital Centre, 55000 Bar-le-Duc, France
| | - Karine Lavandier
- Stroke Unit, Bar-le-Duc Hospital Centre, 55000 Bar-le-Duc, France
| | - Sophie Marchal
- Stroke Unit, Verdun Hospital Centre, 55100 Verdun, France
| | - Anne Aubertin
- Stroke Unit, Hospital Centre Troyes, CS 20718, 10003 Troyes, France
| | - Lisa Humbertjean
- Department of Neurology, Stroke Unit, University Hospital Centre Nancy, 54035 Nancy, France
| | - Gioia Mione
- Department of Neurology, Stroke Unit, University Hospital Centre Nancy, 54035 Nancy, France
| | - Sanae Bouali
- Plurithematic Clinical Investigation Center, CIC-P 1433, INSERM U1116, University Hospital Centre Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Kevin Duarte
- Plurithematic Clinical Investigation Center, CIC-P 1433, INSERM U1116, University Hospital Centre Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Sandrine Reymond
- Department of Human Protein Sciences, University of Geneva Medical Centre, 1206 Geneva, Switzerland
| | - Benjamin Gory
- University of Lorraine, Nancy, France
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, University Hospital Centre Nancy, 54035 Nancy, France
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, University Hospital Centre Nancy, 54035 Nancy, France
- University of Lorraine, Nancy, France
- Plurithematic Clinical Investigation Center, CIC-P 1433, INSERM U1116, University Hospital Centre Nancy, 54500 Vandoeuvre-lès-Nancy, France
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16
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Luger S, Jæger HS, Dixon J, Bohmann FO, Schaefer J, Richieri SP, Larsen K, Hov MR, Bache KG, Foerch C. Diagnostic Accuracy of Glial Fibrillary Acidic Protein and Ubiquitin Carboxy-Terminal Hydrolase-L1 Serum Concentrations for Differentiating Acute Intracerebral Hemorrhage from Ischemic Stroke. Neurocrit Care 2021; 33:39-48. [PMID: 32096121 DOI: 10.1007/s12028-020-00931-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Biomarkers indicative of intracerebral hemorrhage (ICH) may help triage acute stroke patients in the pre-hospital phase. We hypothesized that serum concentration of glial fibrillary acidic protein (GFAP) in combination with ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1), measured by a rapid bio-assay, could be used to distinguish ICH from ischemic stroke. METHODS This prospective two-center study recruited patients with a clinical diagnosis of acute stroke both in the pre-hospital phase and at hospital admission (within 4 and 6 h after symptom onset, respectively). Blood samples were analyzed for concentrations of GFAP and UCH-L1 using ELISA techniques. The reference standard was the diagnosis of ICH, ischemic stroke, or stroke mimicking condition achieved after clinical workup including brain imaging. RESULTS A total of 251 patients were included (mean age [± SD] 72 ± 15 years; 5 ICH, 23 ischemic strokes and 14 stroke mimics in the pre-hospital part; and 59 ICH, 148 ischemic strokes and 2 stroke mimics in the in-hospital part). Mean delay (± SD) from symptom onset to blood withdrawal was 130 ± 79 min for the pre-hospital patients and 136 ± 86 min for the in-hospital patients. Both GFAP and UCH-L1 serum concentrations were higher in patients having ICH as compared to other diagnoses (GFAP: median 330 ng/L [interquartile range 64-7060, range 8-56,100] vs. 27.5 ng/L [14-57.25, 0-781], p < 0.001; UCH-L1: 401 ng/L [265-764, 133-1812] vs. 338 ng/L [213-549.5, 0-2950], p = 0.025). Area-under-the-curve values were 0.866 (95% CI 0.809-0.924, p < 0.001) for GFAP, and 0.590 (0.511-0.670, p = 0.033) for UCH-L1. Regarding overall diagnostic accuracy, UCH-L1 did not add significantly to the performance of GFAP. CONCLUSIONS GFAP may differentiate ICH from ischemic stroke and stroke mimics. A point-of-care test to distinguish between ischemic and hemorrhagic strokes might facilitate triage to different treatment pathways or locations, or be used to select patients for trials of ultra-early interventions.
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Affiliation(s)
- Sebastian Luger
- Department of Neurology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
| | - Henriette S Jæger
- The Norwegian Air Ambulance Foundation, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Joanna Dixon
- Department of Neurology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Ferdinand O Bohmann
- Department of Neurology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - JanHendrik Schaefer
- Department of Neurology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | | | - Karianne Larsen
- The Norwegian Air Ambulance Foundation, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Maren R Hov
- The Norwegian Air Ambulance Foundation, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Kristi G Bache
- The Norwegian Air Ambulance Foundation, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Christian Foerch
- Department of Neurology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
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17
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Mattila OS, Ashton NJ, Blennow K, Zetterberg H, Harve-Rytsälä H, Pihlasviita S, Ritvonen J, Sibolt G, Nukarinen T, Curtze S, Strbian D, Pystynen M, Tatlisumak T, Kuisma M, Lindsberg PJ. Ultra-Early Differential Diagnosis of Acute Cerebral Ischemia and Hemorrhagic Stroke by Measuring the Prehospital Release Rate of GFAP. Clin Chem 2021; 67:1361-1372. [PMID: 34383905 DOI: 10.1093/clinchem/hvab128] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/11/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Plasma glial fibrillary acidic protein (GFAP) and tau are promising markers for differentiating acute cerebral ischemia (ACI) and hemorrhagic stroke (HS), but their prehospital dynamics and usefulness are unknown. METHODS We performed ultra-sensitivite single-molecule array (Simoa®) measurements of plasma GFAP and total tau in a stroke code patient cohort with cardinal stroke symptoms [National Institutes of Health Stroke Scale (NIHSS) ≥3]. Sequential sampling included 2 ultra-early samples, and a follow-up sample on the next morning. RESULTS We included 272 cases (203 ACI, 60 HS, and 9 stroke mimics). Median (IQR) last-known-well to sampling time was 53 (35-90) minutes for initial prehospital samples, 90 (67-130) minutes for secondary acute samples, and 21 (16-24) hours for next morning samples. Plasma GFAP was significantly higher in patients with HS than ACI (P < 0.001 for <1 hour and <3 hour prehospital samples, and <3 hour secondary samples), while total tau showed no intergroup difference. The prehospital GFAP release rate (pg/mL/minute) occurring between the 2 very early samples was significantly higher in patients with HS than ACI [2.4 (0.6-14.1)] versus 0.3 (-0.3-0.9) pg/mL/minute, P < 0.001. For cases with <3 hour prehospital sampling (ACI n = 178, HS n = 59), a combined rule (prehospital GFAP >410 pg/mL, or prehospital GFAP 90-410 pg/mL together with GFAP release >0.6 pg/mL/minute) enabled ruling out HS with high certainty (NPV 98.4%) in 68% of patients with ACI (sensitivity for HS 96.6%, specificity 68%, PPV 50%). CONCLUSIONS In comparison to single-point measurement, monitoring the prehospital GFAP release rate improves ultra-early differentiation of stroke subtypes. With serial measurement GFAP has potential to improve future prehospital stroke diagnostics .
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Affiliation(s)
- Olli S Mattila
- Neurology and Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Heini Harve-Rytsälä
- Emergency Medicine and Services, Department of Emergency Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Saana Pihlasviita
- Neurology and Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juhani Ritvonen
- Neurology and Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Gerli Sibolt
- Neurology and Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Nukarinen
- Neurology and Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sami Curtze
- Neurology and Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniel Strbian
- Neurology and Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Pystynen
- Emergency Medicine and Services, Department of Emergency Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Markku Kuisma
- Emergency Medicine and Services, Department of Emergency Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Perttu J Lindsberg
- Neurology and Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Integrative Multi-omics Analysis to Characterize Human Brain Ischemia. Mol Neurobiol 2021; 58:4107-4121. [PMID: 33939164 DOI: 10.1007/s12035-021-02401-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/21/2021] [Indexed: 01/14/2023]
Abstract
Stroke is a major cause of death and disability. A better comprehension of stroke pathophysiology is fundamental to reduce its dramatic outcome. The use of high-throughput unbiased omics approaches and the integration of these data might deepen the knowledge of stroke at the molecular level, depicting the interaction between different molecular units. We aimed to identify protein and gene expression changes in the human brain after ischemia through an integrative approach to join the information of both omics analyses. The translational potential of our results was explored in a pilot study with blood samples from ischemic stroke patients. Proteomics and transcriptomics discovery studies were performed in human brain samples from six deceased stroke patients, comparing the infarct core with the corresponding contralateral brain region, unveiling 128 proteins and 2716 genes significantly dysregulated after stroke. Integrative bioinformatics analyses joining both datasets exposed canonical pathways altered in the ischemic area, highlighting the most influential molecules. Among the molecules with the highest fold-change, 28 genes and 9 proteins were selected to be validated in five independent human brain samples using orthogonal techniques. Our results were confirmed for NCDN, RAB3C, ST4A1, DNM1L, A1AG1, A1AT, JAM3, VTDB, ANXA1, ANXA2, and IL8. Finally, circulating levels of the validated proteins were explored in ischemic stroke patients. Fluctuations of A1AG1 and A1AT, both up-regulated in the ischemic brain, were detected in blood along the first week after onset. In summary, our results expand the knowledge of ischemic stroke pathology, revealing key molecules to be further explored as biomarkers and/or therapeutic targets.
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19
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Bustamante A, Penalba A, Orset C, Azurmendi L, Llombart V, Simats A, Pecharroman E, Ventura O, Ribó M, Vivien D, Sanchez JC, Montaner J. Blood Biomarkers to Differentiate Ischemic and Hemorrhagic Strokes. Neurology 2021; 96:e1928-e1939. [PMID: 33674361 DOI: 10.1212/wnl.0000000000011742] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 01/13/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To validate a panel of blood biomarkers to differentiate between ischemic stroke (IS) and intracerebral hemorrhage (ICH) in patients with suspected stroke. METHODS Patients with suspected stroke admitted within 4.5 hours after onset were enrolled. Blood samples were collected at hospital admission. Glial fibrillary acid protein (GFAP), retinol binding protein 4 (RBP-4), N-terminal proB-type natriuretic peptide (NT-proBNP), and endostatin were measured by immunoassays. Cutoff points were obtained for 100% specificity for IS. A high-sensitivity assay to measure GFAP and rapid point-of-care tests (POCTs) to measure RBP-4 and NT-proBNP were used in subsets of patients. Biomarker panels were evaluated in another cohort of 62 stroke mimics. RESULTS A total of 189 patients (154 IS and 35 ICH) were enrolled. Patients with IS had higher RBP-4, NT-proBNP, and endostatin and lower GFAP levels than patients with ICH. The best biomarker combination for the identification of IS was RBP-4+NT-proBNP, which was able to identify 29.7% of patients with IS with 100% specificity. In the subset of patients for whom GFAP was measured with the high-sensitivity assay, RBP-4, NT-proBNP, and GFAP identified 51.5% of patients with IS with 100% specificity. When stroke mimics were included, specificities were reduced to 98.4 and 96.8%, respectively. POCTs of RBP-4 and NT-proBNP showed results similar results to those of conventional ELISAs. CONCLUSIONS A biomarker panel including RBP-4, NT-proBNP, and GFAP provided moderate but potentially useful sensitivity rates at 100% specificity for IS diagnosis. If confirmed in future studies, this strategy might allow prehospital treatment in selected patients. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that a biomarker panel including RBP-4, NT-proBNP, and GFAP distinguishes IS from ICH with moderate accuracy.
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Affiliation(s)
- Alejandro Bustamante
- From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France
| | - Anna Penalba
- From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France
| | - Cyrille Orset
- From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France
| | - Leire Azurmendi
- From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France
| | - Víctor Llombart
- From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France
| | - Alba Simats
- From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France
| | - Emili Pecharroman
- From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France
| | - Oriol Ventura
- From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France
| | - Marc Ribó
- From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France
| | - Denis Vivien
- From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France
| | - Jean Charles Sanchez
- From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France
| | - Joan Montaner
- From the Neurovascular Research Laboratory (A.B., A.P., V.L., A.S., E.P., O.V., J.M.), Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona; Department of Neurology (A.B., M.R.), Hospital Universitari Vall d'Hebrón, Barcelona, Spain; Inserm (C.O., D.V.), Université Caen-Normandie, Inserm UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Caen, France; Department of Specialities of Internal Medicine (L.A., J.C.S.), Faculty of Medicine, University of Geneva, Switzerland; and Department of Clinical Research (D.V.), Caen Normandie Hospital (CHU Caen), France.
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20
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Dagonnier M, Donnan GA, Davis SM, Dewey HM, Howells DW. Acute Stroke Biomarkers: Are We There Yet? Front Neurol 2021; 12:619721. [PMID: 33633673 PMCID: PMC7902038 DOI: 10.3389/fneur.2021.619721] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/14/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Distinguishing between stroke subtypes and knowing the time of stroke onset are critical in clinical practice. Thrombolysis and thrombectomy are very effective treatments in selected patients with acute ischemic stroke. Neuroimaging helps decide who should be treated and how they should be treated but is expensive, not always available and can have contraindications. These limitations contribute to the under use of these reperfusion therapies. Aim: An alternative approach in acute stroke diagnosis is to identify blood biomarkers which reflect the body's response to the damage caused by the different types of stroke. Specific blood biomarkers capable of differentiating ischemic from hemorrhagic stroke and mimics, identifying large vessel occlusion and capable of predicting stroke onset time would expedite diagnosis and increase eligibility for reperfusion therapies. Summary of Review: To date, measurements of candidate biomarkers have usually occurred beyond the time window for thrombolysis. Nevertheless, some candidate markers of brain tissue damage, particularly the highly abundant glial structural proteins like GFAP and S100β and the matrix protein MMP-9 offer promising results. Grouping of biomarkers in panels can offer additional specificity and sensitivity for ischemic stroke diagnosis. Unbiased “omics” approaches have great potential for biomarker identification because of greater gene, protein, and metabolite coverage but seem unlikely to be the detection methodology of choice because of their inherent cost. Conclusion: To date, despite the evolution of the techniques used in their evaluation, no individual candidate or multimarker panel has proven to have adequate performance for use in an acute clinical setting where decisions about an individual patient are being made. Timing of biomarker measurement, particularly early when decision making is most important, requires urgent and systematic study.
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Affiliation(s)
- Marie Dagonnier
- Stroke Division, Melbourne Brain Centre, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.,Department of Neurology, Ambroise Paré Hospital, Mons, Belgium
| | - Geoffrey A Donnan
- Stroke Division, Melbourne Brain Centre, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.,Melbourne Brain Centre at the Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - Stephen M Davis
- Melbourne Brain Centre at the Royal Melbourne Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - Helen M Dewey
- Stroke Division, Melbourne Brain Centre, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - David W Howells
- Stroke Division, Melbourne Brain Centre, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.,Faculty of Health, School of Medicine, University of Tasmania, Hobart, TAS, Australia
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21
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Intracerebral Hemorrhage with Intraventricular Extension Associated with Loss of Consciousness at Symptom Onset. Neurocrit Care 2021; 35:418-427. [PMID: 33479920 PMCID: PMC8578176 DOI: 10.1007/s12028-020-01180-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/15/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND In patients with spontaneous intracerebral hemorrhage (ICH), pre-hospital markers of disease severity might be useful to potentially triage patients to undergo early interventions. OBJECTIVE Here, we tested whether loss of consciousness (LOC) at the onset of ICH is associated with intraventricular hemorrhage (IVH) on brain computed tomography (CT). METHODS Among 3000 ICH cases from ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage study, NS069763), we included patients with complete ICH/IVH volumetric CT measurements and excluded those with seizures at ICH onset. Trained investigators extracted data from medical charts. Mental status at symptom onset (categorized as alert/oriented, alert/confused, drowsy/somnolent, coma/unresponsive/posturing) and 3-month disability (modified Rankin score, mRS) were assessed through standardized interviews of participants or dedicated proxies. We used logistic regression and mediation analysis to assess relationships between LOC, IVH, and unfavorable outcome (mRS 4-6). RESULTS Two thousand seven hundred and twenty-four patients met inclusion criteria. Median admission Glasgow Coma Score was 15 (interquartile range 11-15). 46% had IVH on admission or follow-up CT. Patients with LOC (mental status: coma/unresponsive, n = 352) compared to those without LOC (all other mental status, n = 2372) were younger (60 vs. 62 years, p = 0.005) and had greater IVH frequency (77 vs. 41%, p < 0.001), greater peak ICH volumes (28 vs. 11 ml, p < 0.001), greater admission systolic blood pressure (200 vs. 184 mmHg, p < 0.001), and greater admission serum glucose (158 vs. 127 mg/dl, p < 0.001). LOC was independently associated with IVH presence (odds ratio, OR, 2.6, CI 1.9-3.5) and with unfavorable outcome (OR 3.05, CI 1.96-4.75). The association between LOC and outcome was significantly mediated by IVH (beta = 0.24, bootstrapped CI 0.17-0.32). CONCLUSION LOC at ICH onset may be a useful pre-hospital marker to identify patients at risk of having or developing IVH.
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22
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Michalski D, Spielvogel E, Puchta J, Reimann W, Barthel H, Nitzsche B, Mages B, Jäger C, Martens H, Horn AKE, Schob S, Härtig W. Increased Immunosignals of Collagen IV and Fibronectin Indicate Ischemic Consequences for the Neurovascular Matrix Adhesion Zone in Various Animal Models and Human Stroke Tissue. Front Physiol 2020; 11:575598. [PMID: 33192578 PMCID: PMC7649770 DOI: 10.3389/fphys.2020.575598] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/23/2020] [Indexed: 12/21/2022] Open
Abstract
Ischemic stroke causes cellular alterations in the “neurovascular unit” (NVU) comprising neurons, glia, and the vasculature, and affects the blood-brain barrier (BBB) with adjacent extracellular matrix (ECM). Limited data are available for the zone between the NVU and ECM that has not yet considered for neuroprotective approaches. This study describes ischemia-induced alterations for two main components of the neurovascular matrix adhesion zone (NMZ), i.e., collagen IV as basement membrane constituent and fibronectin as crucial part of the ECM, in conjunction with traditional NVU elements. For spatio-temporal characterization of these structures, multiple immunofluorescence labeling was applied to tissues affected by focal cerebral ischemia using a filament-based model in mice (4, 24, and 72 h of ischemia), a thromboembolic model in rats (24 h of ischemia), a coagulation-based model in sheep (2 weeks of ischemia), and human autoptic stroke tissue (3 weeks of ischemia). An increased fibronectin immunofluorescence signal demarcated ischemia-affected areas in mice, along with an increased collagen IV signal and BBB impairment indicated by serum albumin extravasation. Quantifications revealed a region-specific pattern with highest collagen IV and fibronectin intensities in most severely affected neocortical areas, followed by a gradual decline toward the border zone and non-affected regions. Comparing 4 and 24 h of ischemia, the subcortical fibronectin signal increased significantly over time, whereas neocortical areas displayed only a gradual increase. Qualitative analyses confirmed increased fibronectin and collagen IV signals in ischemic areas from all tissues and time points investigated. While the increased collagen IV signal was restricted to vessels, fibronectin appeared diffusely arranged in the parenchyma with focal accumulations associated to the vasculature. Integrin α5 appeared enriched in the vicinity of fibronectin and vascular elements, while most of the non-vascular NVU elements showed complementary staining patterns referring to fibronectin. This spatio-temporal characterization of ischemia-related alterations of collagen IV and fibronectin in various stroke models and human autoptic tissue shows that ischemic consequences are not limited to traditional NVU components and the ECM, but also involve the NMZ. Future research should explore more components and the pathophysiological properties of the NMZ as a possible target for novel neuroprotective approaches.
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Affiliation(s)
| | - Emma Spielvogel
- Department of Neurology, University of Leipzig, Leipzig, Germany.,Paul Flechsig Institute for Brain Research, University of Leipzig, Leipzig, Germany
| | - Joana Puchta
- Paul Flechsig Institute for Brain Research, University of Leipzig, Leipzig, Germany.,Department of Neuroradiology, University of Leipzig, Leipzig, Germany
| | - Willi Reimann
- Department of Neurology, University of Leipzig, Leipzig, Germany.,Paul Flechsig Institute for Brain Research, University of Leipzig, Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Björn Nitzsche
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany.,Institute of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Bianca Mages
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Carsten Jäger
- Paul Flechsig Institute for Brain Research, University of Leipzig, Leipzig, Germany
| | | | - Anja K E Horn
- Institute of Anatomy and Cell Biology I and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
| | - Stefan Schob
- Department of Neuroradiology, University of Leipzig, Leipzig, Germany
| | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, University of Leipzig, Leipzig, Germany
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23
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Cabezas JA, Bustamante A, Giannini N, Pecharroman E, Katsanos AH, Tsivgoulis G, Rozanski M, Audebert H, Mondello S, Llombart V, Montaner J. Discriminative value of glial fibrillar acidic protein (GFAP) as a diagnostic tool in acute stroke. Individual patient data meta-analysis. J Investig Med 2020; 68:1379-1385. [PMID: 32907910 DOI: 10.1136/jim-2020-001432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 01/30/2023]
Abstract
Glial fibrillar acidic protein (GFAP) in serum has been evaluated as a promising biomarker to differentiate between intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS). We assessed its value as diagnostic and prognostic tool for ICH through a literature systematic review and individual patient data (IPD) meta-analysis.We performed a systematic search in PubMed database until November 2018 for publications that evaluated GFAP to differentiate AIS and ICH within 4.5 hours after symptoms onset. Thereafter, we invited authors of selected studies to participate in this work by providing IPD from their cohorts. We used standardized individual subject's data to evaluate the association of GFAP concentrations with stroke subtype, demographics, stroke characteristics and factors related with GFAP measurement.From 4 selected studies, we collected data of 340 patients (236 AIS and 104 ICH). Standardized GFAP blood levels were significantly elevated in ICH compared with those with AIS (median and IQR: 0.84 (0.781-1.24), 0.79 (0.74-0.81); p<0.0001). In both stroke types, GFAP concentrations correlated with baseline stroke severity (r=0.27, p<0.0001; r=0.36, p<0.001; for AIS and ICH, respectively) but no correlation was found regarding time to sampling. Limited data precluded the evaluation of GFAP levels and functional outcome.These findings demonstrate substantially different levels of GFAP in the blood of patients with ICH compared with patients with AIS soon after the event, while no association was found with outcome. In summary, GFAP could be a valuable diagnostic tool to assist in medical decision-making and to optimize management of stroke in the acute setting.
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Affiliation(s)
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Emilio Pecharroman
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Georgios Tsivgoulis
- Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Michal Rozanski
- Department of Neurology, Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
| | - Heinrich Audebert
- Department of Neurology, Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin, Berlin, Germany
| | - Stefania Mondello
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy
| | - Victor Llombart
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurology, Virgen Macarena University Hospital, Sevilla, Spain .,Neurovascular Laboratory, Vall d'Hebron Hospital, Barcelona, Spain
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24
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Misra S, Montaner J, Ramiro L, Arora R, Talwar P, Nath M, Kumar A, Kumar P, Pandit AK, Mohania D, Prasad K, Vibha D. Blood biomarkers for the diagnosis and differentiation of stroke: A systematic review and meta-analysis. Int J Stroke 2020; 15:704-721. [DOI: 10.1177/1747493020946157] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Correct diagnosis of stroke and its subtypes is pivotal in early stages for optimum treatment. Aims The aim of this systematic review and meta-analysis is to summarize the published evidence on the potential of blood biomarkers in the diagnosis and differentiation of stroke subtypes. Methods A literature search was conducted for papers published until 20 April 2020 in PubMed, EMBASE, Cochrane Library, TRIP, and Google Scholar databases to search for eligible studies investigating the role of blood biomarkers in diagnosing stroke. Quality assessment was done using modified Quality Assessment of Diagnostic Accuracy Studies questionnaire. Pooled standardized mean difference and 95% confidence intervals were calculated. Presence of heterogeneity among the included studies was investigated using the Cochran's Q statistic and I2 metric tests. If I2 was < 50% then a fixed-effect model was applied else a random-effect model was applied. Risk of bias was assessed using funnel plots and between-study heterogeneity was assessed using meta-regression and sensitivity analyses. Entire statistical analysis was conducted in STATA version 13.0. Results A total of 40 studies including patients with 5001 ischemic strokes, 756 intracerebral hemorrhage, 554 stroke mimics, and 1774 healthy control subjects analyzing 25 biomarkers (within 24 h after symptoms onset/after the event) were included in our meta-analysis; 67.5% of studies had moderate evidence of quality. Brain natriuretic peptide, matrix metalloproteinase-9, and D-dimer significantly differentiated ischemic stroke from intracerebral hemorrhage, stroke mimics, and health control subjects ( p < 0.05). Glial fibrillary acidic protein successfully differentiated ischemic stroke from intracerebral hemorrhage (standardized mean difference −1.04; 95% confidence interval −1.46 to −0.63) within 6 h. No studies were found to conduct a meta-analysis of blood biomarkers differentiating transient ischemic attack from healthy controls and stroke mimics. Conclusion This meta-analysis highlights the potential of brain natriuretic peptide, matrix metalloproteinase-9, D-dimer, and glial fibrillary acidic protein as diagnostic biomarkers for stroke within 24 h. Results of our meta-analysis might serve as a platform for conducting further targeted proteomics studies and phase-III clinical trials. PROSPERO Registration ID: CRD42019139659.
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Affiliation(s)
- Shubham Misra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
- Stroke Research Program, Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville & Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Laura Ramiro
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rohan Arora
- Zucker Schoool of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Pumanshi Talwar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manabesh Nath
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Awadh K Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Dheeraj Mohania
- Dr. R.P. Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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25
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Ferro JM. Biomarkers and aspects in acute stroke. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:245-246. [PMID: 32490961 DOI: 10.1590/0004-282x20200050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Affiliation(s)
- José Manuel Ferro
- Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Departamento de Neurociências e Saúde Mental, Serviço de Neurologia, Lisboa, Portugal
- Universidade de Lisboa, Faculdade de Medicina, Instituto de Medicina Molecular, Lisboa, Portugal
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26
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Multilevel omics for the discovery of biomarkers and therapeutic targets for stroke. Nat Rev Neurol 2020; 16:247-264. [PMID: 32322099 DOI: 10.1038/s41582-020-0350-6] [Citation(s) in RCA: 147] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 02/07/2023]
Abstract
Despite many years of research, no biomarkers for stroke are available to use in clinical practice. Progress in high-throughput technologies has provided new opportunities to understand the pathophysiology of this complex disease, and these studies have generated large amounts of data and information at different molecular levels. The integration of these multi-omics data means that thousands of proteins (proteomics), genes (genomics), RNAs (transcriptomics) and metabolites (metabolomics) can be studied simultaneously, revealing interaction networks between the molecular levels. Integrated analysis of multi-omics data will provide useful insight into stroke pathogenesis, identification of therapeutic targets and biomarker discovery. In this Review, we detail current knowledge on the pathology of stroke and the current status of biomarker research in stroke. We summarize how proteomics, metabolomics, transcriptomics and genomics are all contributing to the identification of new candidate biomarkers that could be developed and used in clinical stroke management.
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Chen CH, Cheng YW, Chen YF, Tang SC, Jeng JS. Plasma neurofilament light chain and glial fibrillary acidic protein predict stroke in CADASIL. J Neuroinflammation 2020; 17:124. [PMID: 32321529 PMCID: PMC7175500 DOI: 10.1186/s12974-020-01813-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background Stroke remains the most cumbersome disease burden in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). This study aimed to investigate whether plasma biomarkers can reflect disease severity and predict stroke recurrence in CADASIL patients. Methods Sixty-three CADASIL patients (mean age 58.9 ± 9.3 years old, male 63%) from a multicenter registry and 17 controls were recruited. Plasma biomarkers, namely neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), tau, and ubiquitin carboxy-terminal hydrolase L1 (UCHL1), were measured using an ultra-sensitive single molecule array at baseline. Neuroimaging markers assessed included the Fazekas scale of white matter hyperintensity, numbers of lacunes, and cerebral microbleeds (CMBs). Cox proportional hazards regression models were applied to calculate the hazard ratio (HR) of plasma biomarkers at baseline for predicting incident stroke during follow-up. Results Plasma NfL, GFAP, and UCHL1 levels were significantly elevated in the CADASIL patients than in the controls. Among the CADASIL patients, both plasma NfL and GFAP levels positively correlated with the numbers of CMBs (r = 0.32 and r = 0.37, respectively; both p < 0.05). Higher plasma levels of NfL and GFAP were associated with any stroke (odds ratio 2.02, 95% confidence interval [CI] 1.06–3.87) and ICH (odds ratio 2.06, 95% CI 1.26–3.35) at baseline, respectively. Within a mean follow-up period of 3.1 ± 2.1 years, 10 patients (16%) had incident stroke and 6 of them were ICH. Higher baseline NfL (HR 1.93, 95% CI 1.19–3.13) predicted any incident stroke, whereas higher GFAP (HR 2.80, 95% CI 1.21–6.53) predicted incident ICH. Conclusions In CADASIL patients, plasma NfL can be a promising biomarker for monitoring incident stroke, whereas GFAP may have a role in cerebral hemorrhage.
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Affiliation(s)
- Chih-Hao Chen
- Stroke Center and Department of Neurology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10055, Taiwan.,Graduate Institute of Epidemiology and Preventive Medicine (CHC), College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Wen Cheng
- Department of Neurology, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Ya-Fang Chen
- Department of Medical Imaging (YFC), National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Chun Tang
- Stroke Center and Department of Neurology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10055, Taiwan.
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10055, Taiwan
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28
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Mondello S, Salama MM, Mohamed WMY, Kobeissy FH. Editorial: Biomarkers in Neurology. Front Neurol 2020; 11:190. [PMID: 32256443 PMCID: PMC7093560 DOI: 10.3389/fneur.2020.00190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/28/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Mohamed Mosaad Salama
- Institute of Global Health and Human Ecology, American University in Cairo, Cairo, Egypt
| | - Wael M Y Mohamed
- Clinical Pharmacology Department, Menoufia Medical School, Menoufia University, Al Minufya, Egypt.,Department of Basic Medical Science, Kulliyyah of Medicine, International Islamic University, Kuantan, Malaysia
| | - Firas H Kobeissy
- Department of Emergency Medicine, University of Florida, Gainesville, FL, United States.,Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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29
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Kamtchum-Tatuene J, Jickling GC. Blood Biomarkers for Stroke Diagnosis and Management. Neuromolecular Med 2019; 21:344-368. [PMID: 30830566 PMCID: PMC6722038 DOI: 10.1007/s12017-019-08530-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/19/2019] [Indexed: 12/20/2022]
Abstract
Biomarkers are objective indicators used to assess normal or pathological processes, evaluate responses to treatment and predict outcomes. Many blood biomarkers already guide decision-making in clinical practice. In stroke, the number of candidate biomarkers is constantly increasing. These biomarkers include proteins, ribonucleic acids, lipids or metabolites. Although biomarkers have the potential to improve the diagnosis and the management of patients with stroke, there is currently no marker that has demonstrated sufficient sensitivity, specificity, rapidity, precision, and cost-effectiveness to be used in the routine management of stroke, thus highlighting the need for additional work. A better standardization of clinical, laboratory and statistical procedures between centers is indispensable to optimize biomarker performance. This review focuses on blood biomarkers that have shown promise for translation into clinical practice and describes some newly reported markers that could add to routine stroke care. Avenues for the discovery of new stroke biomarkers and future research are discussed. The description of the biomarkers is organized according to their expected application in clinical practice: diagnosis, treatment decision, and outcome prediction.
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Affiliation(s)
- Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, 4-120 Katz Building, 114 Street & 87 Avenue, Edmonton, AB, T6G 2E1, Canada.
| | - Glen C Jickling
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, 4-120 Katz Building, 114 Street & 87 Avenue, Edmonton, AB, T6G 2E1, Canada
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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