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Liu Z, Yang C, Wang X, Xiang Y. Blood-Based Biomarkers: A Forgotten Friend of Hyperacute Ischemic Stroke. Front Neurol 2021; 12:634717. [PMID: 34168606 PMCID: PMC8217611 DOI: 10.3389/fneur.2021.634717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/21/2021] [Indexed: 11/21/2022] Open
Abstract
Ischemic stroke (IS) is the second leading cause of death worldwide. Multimodal neuroimaging techniques that have significantly facilitated the diagnosis of hyperacute IS are not widely used in underdeveloped areas and community hospitals owing to drawbacks such as high cost and lack of trained operators. Moreover, these methods do not have sufficient resolution to detect changes in the brain at the cellular and molecular levels after IS onset. In contrast, blood-based biomarkers can reflect molecular and biochemical alterations in both normal and pathophysiologic processes including angiogenesis, metabolism, inflammation, oxidative stress, coagulation, thrombosis, glial activation, and neuronal and vascular injury, and can thus provide information complementary to findings from routine examinations and neuroimaging that is useful for diagnosis. In this review, we summarize the current state of knowledge on blood-based biomarkers of hyperacute IS including those associated with neuronal injury, glial activation, inflammation and oxidative stress, vascular injury and angiogenesis, coagulation and thrombosis, and metabolism as well as genetic and genomic biomarkers. Meanwhile, the blood sampling time of the biomarkers which are cited and summarized in the review is within 6 h after the onset of IS. Additionally, we also discuss the diagnostic and prognostic value of blood-based biomarkers in stroke patients, and future directions for their clinical application and development.
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Affiliation(s)
- Zhilan Liu
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China.,Department of Neurology, General Hospital of Western Theater Command, Chengdu, China.,North Sichuan Medical College, Nanchong, China
| | - Cui Yang
- Institute of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Xiaoming Wang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yang Xiang
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Gallego-Fabrega C, Carrera C, Reny JL, Fontana P, Slowik A, Pera J, Pezzini A, Serrano-Heras G, Segura T, Martí-Fàbregas J, Muiño E, Cullell N, Montaner J, Krupinski J, Fernandez-Cadenas I. TRAF3
Epigenetic Regulation Is Associated With Vascular Recurrence in Patients With Ischemic Stroke. Stroke 2016; 47:1180-6. [DOI: 10.1161/strokeaha.115.012237] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/01/2016] [Indexed: 01/25/2023]
Abstract
Background and Purpose—
Clopidogrel is one of the most used antiplatelet drugs in patients with cardiovascular disease. However, 16% to 50% of patients have a high on-clopidogrel platelet reactivity and an increased risk of ischemic events. The pathogenesis of high on-treatment platelet reactivity in patients with stroke is only partially explained by genetic variations. This study aims to find differentially methylated sites across the genome associated with vascular recurrence in ischemic stroke patients treated with clopidogrel.
Methods—
From a cohort of 1900 patients with ischemic stroke, we selected 42 patients treated with clopidogrel, including 21 with a recurrent vascular event and 21 without vascular recurrence during the first year of follow-up. Over 480 000 DNA methylation sites were analyzed across the genome. Differentially methylated CpG sites were identified by nonparametric testing using R. Replication analysis was performed in a new cohort of 191 subjects and results were correlated with platelet reactivity in a subset of 90 subjects using light transmission aggregometry.
Results—
A total of 73 differentially methylated CpG sites (
P
<1×10
−05
) were identified; 3 of them were selected for further replication: cg03548645 (
P
=1.42×10
−05
,
TRAF3
), cg09533145 (
P
=7.81×10
−06
,
ADAMTS2
), and cg15107336 (
P
=1.89×10
−05
,
XRCC1
). The cg03548645 CpG remained significant in the replication study (
P
=0.034), a deep analysis of this region revealed another methylation site associated with vascular recurrence,
P
=0.037. Lower cg03548645 (
TRAF3
) DNA methylation levels were correlated with an increased platelet aggregation (ρ=−0.29,
P
=0.0075).
Conclusions—
This study suggests for the first time that epigenetics may significantly contribute to the variability of clopidogrel response and recurrence of ischemic events in patients with stroke.
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Affiliation(s)
- Cristina Gallego-Fabrega
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Caty Carrera
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Jean-Luc Reny
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Pierre Fontana
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Agnieszka Slowik
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Joanna Pera
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Alessandro Pezzini
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Gemma Serrano-Heras
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Tomás Segura
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Joan Martí-Fàbregas
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Elena Muiño
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Natalia Cullell
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Joan Montaner
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Jerzy Krupinski
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Israel Fernandez-Cadenas
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
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