Acute stroke biomarkers: Are we there yet?

Background: Distinguishing between stroke subtypes and knowing the time of strokeonset are critical in clinical practice. Thrombolysis and thrombectomy are very effectivetreatments in selected patients with acute ischemic stroke. Neuroimaging helps decidewho should be treated and how they should be treated but is expensive, not alwaysavailable and can have contraindications. These limitations contribute to the under useof these reperfusion therapies.Aim: An alternative approach in acute stroke diagnosis is to identify blood biomarkerswhich reflect the body’s response to the damage caused by the different types of stroke.Specific blood biomarkers capable of differentiating ischemic from hemorrhagic strokeand mimics, identifying large vessel occlusion and capable of predicting stroke onsettime would expedite diagnosis and increase eligibility for reperfusion therapies.Summary of Review: To date, measurements of candidate biomarkers have usuallyoccurred beyond the time window for thrombolysis. Nevertheless, some candidatemarkers of brain tissue damage, particularly the highly abundant glial structural proteinslike GFAP and S100β and the matrix protein MMP-9 offer promising results. Groupingof biomarkers in panels can offer additional specificity and sensitivity for ischemic strokediagnosis. Unbiased “omics” approaches have great potential for biomarker identificationbecause of greater gene, protein, and metabolite coverage but seem unlikely to be thedetection methodology of choice because of their inherent cost.Conclusion: To date, despite the evolution of the techniques used in their evaluation, noindividual candidate or multimarker panel has proven to have adequate performance foruse in an acute clinical setting where decisions about an individual patient are beingmade. Timing of biomarker measurement, particularly early when decision making ismost important, requires urgent and systematic study